The cause of complications: understanding the relation between post-operative complications and the systems and processes of a hospital by means of an influence diagram

Care for the patient is the core process of hospital care. Hospitals are becoming ever more complex and it is increasingly difficult to have a good overview of the hospital to ensure the quality of care. Among others, additional quality assurance and validation is required to remain in control of the situation. To acquire insight into the most important parameters in patient care, an influence diagram is made of the patient treatment process in the operating room. The outcome of this approach is an extensive diagram, giving an overview of the influences on post-operative complications in a hospital. Based on this, a concise abstraction is made, in which the occurrence of post-operative complications is summarized using a simple system diagram. The main challenges within the current system are identified, and will be used for further research. Preliminary solutions follow from the influence diagram: the essential parameters and the complex interrelations between these parameters are described

The economic and ecological effects of water management choices in the upper Niger river: Development of decision support methods

One million people in the Inner Niger Delta make a living from arable farming, fisheries and livestock. Upstream dams (one built for electricity generation and one for irrigation) affect this downstream multifunctional use of water. Additionally, the Inner Niger Delta, which is one of the largest Ramsar sites in the world, is a hotspot of biodiversity and accommodates two of the largest known breeding colonies of large wading birds in Africa and in addition, is a vital part of the eco-regional network, supporting up to 3 to 4 million staging waterbirds, residents and migrants from all over Europe and western Asia. The hydrological and related ecological conditions in the Inner Delta largely determine the population size of these waterbird species. The major aim of the three-year study was to develop a decision-support system for river management in the Upper Niger, in which ecological and socio-economical impacts and benefits of dams and irrigation systems can be analysed in relation to different water management scenarios. The study involves various components: hydrology, arable farming, livestock, fisheries, ecology and socio-economics. An economic analysis has been conducted to determine the role of dams in the economy of the Inner Niger Delta and the Upper Niger region. By innovatively combining the above information on hydrology, ecology, fisheries, and agriculture, the study shows that building new dams is not an efficient way to increase economic growth and reduce poverty in the region. In fact, such efforts are counter-effective. Instead, development efforts should be aimed at improving the efficiency of the existing infrastructure, as well as of current economic activities in the Inner Niger Delta itself. This approach will also provide greater certainty for the essential eco-regional network functioning of the Inner Delta. © 2006 Taylor & Francis

Deterioration of pulmonary function: An early complication in Fibrodysplasia Ossificans Progressiva

Fibrodysplasia Ossificans Progressiva (FOP) is a genetic disease characterized by the formation of heterotopic ossification (HO) in connective tissues. HO first develops in the thoracic region, before more peripheral sites are affected. Due to HO along the thoracic cage, its movements are restricted and pulmonary function deteriorates. Because development of HO is progressive, it is likely that pulmonary function deteriorates over time, but longitudinal data on pulmonary function in FOP are missing. Longitudinal pulmonary function tests (PFTs) from seven FOP patients were evaluated retrospectively to assess whether there were changes in pulmonary function during aging. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), residual volume (RV) and diffusing lung capacity for carbon dioxide divided by alveolar volume (DLCO/VA) were included. In addition, HO volume along the thorax together with its progression as identified by whole body low dose CT scans were correlated to PFT data. Per patient, aged 7–57 years at the time of the first PFT, three to nine PFTs were available over a period of 6–18 years. Restrictive pulmonary function, identified by TLC or suspected by FVC, was found in all, but one, patients. In three patients, TLC, FVC or both decreased further during the follow-up period. All, but one, patients had an increased RV. The DLCO/VA ratio was normal in all FOP patients. Interestingly, FEV1 increased after a surgical intervention to unlock the jaw. In four out of five patients total HO volume in the thoracic region progressed beyond early adulthood, but no further decline in FVC was observed. In conclusion, restrictive pulmonary function was found in the majority of patients already at an early age. Our data suggest that the deterioration in pulmonary function is age dependent

Advance knowledge effects on kinematics of one-handed catching

The purpose of this experiment was to examine the effects of advance knowledge on the kinematics of one-handed catching. Balls were launched from a distance of 8.4 m by a ball-projection machine with adjustable launching speed. Fifteen skilled ball catchers caught 160 balls with their preferred hand under blocked-order (4 blocks, each comprising 20 trials at 1 of 4 different ball speeds) or random-order (4 blocks, each comprising 20 trials of 4 different ball speeds) conditions. By projecting balls with different ball speeds from a fixed position, it was possible to modify the temporal constraints of the catching task. In both the blocked-order and random-order conditions, catching performance (number of catches, touches and misses) decreased with increasing temporal constraints. Analysis of successful trials indicated that this equal level of catching performance was achieved with different movement kinematics. Specifically, there was a change in movement time, latency, wrist velocity profile, and coefficient of straightness. Based on expectancy of previous trials, movement kinematics was scaled to ball speed in the blocked-order condition whereas in the random-order condition, participants exhibited a more default initial response. However, this latter mode of control was functional in that it increased the likelihood of success for the higher ball speeds while also providing participants with a larger temporal window to negotiate the unexpected temporal constraint on-line for the lowest ball speed

Empirically Based Phenotypic Profiles of Children with Pervasive Developmental Disorders:Interpretation in the Light of the DSM-5

<p>This study aimed to contribute to the Diagnostic and Statistical Manual (DSM) debates on the conceptualization of autism by investigating (1) whether empirically based distinct phenotypic profiles could be distinguished within a sample of mainly cognitively able children with pervasive developmental disorder (PDD), and (2) how profiles related to diagnoses and co-occurring behavioral and emotional problems. Six classes with distinct profiles were discerned. Three classes showed profiles not completely in line with the proposed DSM-5 conceptualization of autism. These classes included relatively many cognitively able individuals with PDD-not otherwise specified. However, profiles seemed to suit other diagnostic categories, such as social communication disorder. These alternative diagnoses could retain eligibility for services, and might adequately fit more specifically targeted interventions.</p>